The Health Impact of Rabies in Haiti and Recent Developments on the Path Toward Elimination, 2010-2015.

Haiti, a Caribbean country of 10.5 million people, is estimated to have the highest burden of canine-mediated human rabies deaths in the Western Hemisphere, and one of the highest rates of human rabies deaths in the world. Haiti is also the poorest country in the Western Hemisphere and has numerous economic and health priorities that compete for rabies-control resources. As a result, primary rabies-control actions, including canine vaccination programs, surveillance systems for human and animal rabies, and appropriate postbite treatment, have not been fully implemented at a national scale. After the 2010 earthquake that further hindered the development of public health program infrastructure and services, the U.S. Centers for Disease Control and Prevention worked with the Ministry of Public Health and Population and key health development partners (including the Pan-American Health Organization) to provide technical expertise and funding for general disease surveillance systems, laboratory capacity, and selected disease control programs; including rabies. In 2011, a cross-ministerial rabies consortium was convened with participation from multiple international rabies experts to develop a strategy for successful rabies control in Haiti. The consortium focused on seven pillars: 1) enhancement of laboratory diagnostic capacity, 2) development of comprehensive animal surveillance system, 3) development of comprehensive human rabies surveillance system, 4) educational outreach, 5) sustainable human rabies biologics supply, 6) achievement of sustained canine vaccination rates of ≥ 70%, and 7) finalization of a national rabies control strategy. From 2010 until 2015, Haiti has seen improvements in the program infrastructure for canine rabies control. The greatest improvements were seen in the area of animal rabies surveillance, in support of which an internationally recognized rabies laboratory was developed thereby leading to an 18-fold increase in the detection of rabid animals. Canine rabies vaccination practices also improved, from a 2010 level of approximately 12% to a 2015 dog population coverage level estimated to be 45%. Rabies vaccine coverage is still below the goal of 70%, however, the positive trend is encouraging. Gaps exist in the capacity to conduct national surveillance for human rabies cases and access to human rabies vaccine is lacking in many parts of the country. However, control has improved over the past 5 years as a result of the efforts of Haiti's health and agriculture sectors with assistance from multiple international organizations. Haiti is well situated to eliminate canine-mediated human rabies deaths in the near future and should serve as a great example to many developing countries struggling with similar barriers and limitations.

Dog Ecology and Barriers to Canine Rabies Control in the Republic of Haiti, 2014-2015.

An estimated 59 000 persons die annually of infection with the rabies virus worldwide, and dog bites are responsible for 95% of these deaths. Haiti has the highest rate of animal and human rabies in the Western Hemisphere. This study describes the status of animal welfare, animal vaccination, human bite treatment, and canine morbidity and mortality in Haiti in order to identify barriers to rabies prevention and control. An epidemiologic survey was used for data collection among dog owners during government-sponsored vaccination clinics at fourteen randomly selected sites from July 2014 to April 2015. A total of 2005 surveys were collected and data were analysed using parametric methods. Over 50% of owned dogs were allowed to roam freely, a factor associated with rabies transmission. More than 80% of dog owners reported experiencing barriers to accessing rabies vaccination for their dogs. Nearly one-third of the dog population evaluated in this study died in the year preceding the survey (32%) and 18% of these deaths were clinically consistent with rabies. Dog bites were commonly reported, with more than 3% of the study population bitten within the year preceding the survey. The incidence of canine rabies in Haiti is high and is exacerbated by low access to veterinary care, free-roaming dog populations and substandard animal welfare practices. Programmes to better understand the dog ecology and development of methods to improve access to vaccines are needed. Rabies deaths are at historical lows in the Western Hemisphere, but Haiti and the remaining canine rabies endemic countries still present a significant challenge to the goal of rabies elimination in the region.

Response of developing countries to biological threats: the case of the Republic of Haiti. / Les pays en développement face aux menaces biologiques : le cas de la République d'Haïti.

In spite of scientific progress, the world is still facing major biological threats. Not only are there epidemics caused by wildlife pathogens under natural conditions, there are also those caused accidently when researchers handle highly hazardous organisms stored in research laboratories, and those caused when countries use these organisms as biological weapons of war or when criminal groups use them for bioterrorism. Developing countries tend to be more vulnerable to such threats than developed countries owing to the poor resilience of their animal health systems, their advanced state of environmental degradation, their socio-economic fragility and their political instability. The occurrence of emerging and re-emerging diseases (avian influenza, Ebola virus disease) has caused deep concern around the world in recent years and has shown how important it is for countries to strengthen the organisation of their Veterinary Services. The Republic of Haiti is one of the developing countries with the most acute biophysical vulnerability. Over the years, it has experienced a large number of earthquakes, hurricanes, floods, droughts and epidemics that have further weakened a country with already scarce financial resources. However, Haiti is endeavouring to address biological threats by modernising its Veterinary Services and by implementing the animal health standards and guidelines of the World Organisation for Animal Health (OIE) for establishing resilient animal health systems.

Malgré les progrès scientifiques, le monde est aujourd'hui encore confronté à de grandes menaces biologiques. Outre les épidémies causées dans des conditions naturelles par des agents pathogènes issus de la faune sauvage, il faut mentionner également celles qui peuvent résulter d'accidents lors de la manipulation de certains germes très dangereux stockés dans les laboratoires de recherche, d'une part, ou de l'utilisation de ces germes par certains pays comme armes biologiques dans les guerres ou par des groupes criminels dans le bioterrorisme, d'autre part. Face à ces menaces, les pays en développement sont généralement plus vulnérables que les pays développés en raison du manque de résilience de leurs systèmes de santé animale, du niveau avancé de dégradation de leur environnement, de leur fragilité socio-économique et de leur instabilité politique. La survenue de maladies émergentes et ré-émergentes (grippe aviaire, maladie d'Ébola) a suscité au cours des dernières années un grand émoi dans le monde et montré combien il est important pour les pays de renforcer l'organisation de leurs Services vétérinaires. Parmi les pays en développement, la République d'Haïti présente une grande vulnérabilité biophysique. Elle a connu au fil du temps un grand nombre de séismes, cyclones, inondations, épisodes de sécheresse et épidémies qui ont encore plus fragilisé ce pays déjà peu pourvu en ressources financières. Toutefois, Haïti essaie de faire face aux menaces biologiques en modernisant ses Services vétérinaires et en appliquant les normes sanitaires et lignes directrices de l'Organisation mondiale de la santé animale (OIE) pour la mise en place de systèmes résilients de santé animale.

A día de hoy, pese a los avances científicos, el mundo sigue afrontando amenazas biológicas de gran calado. Además de las epidemias causadas en condiciones naturales por agentes patógenos procedentes de la fauna salvaje, conviene mencionar las que puedan derivarse de accidentes acaecidos al manipular ciertos gérmenes muy peligrosos almacenados en laboratorios de investigación, por un lado, o del uso de esos gérmenes como arma de guerra biológica por parte de ciertos países o con fines de bioterrorismo por parte de grupos criminales, por el otro. Ante tales amenazas, los países en desarrollo suelen ser más vulnerables que los desarrollados porque sus sistemas de sanidad animal carecen de resiliencia, su medio ambiente está degradado y son socioeconómicamente frágiles y políticamente inestables. En los últimos años el advenimiento de enfermedades emergentes y reemergentes (influenza aviar, enfermedad por el virus del Ébola) ha generado gran desazón en todo el mundo y demostrado cuán importante es para los países reforzar la organización de sus Servicios Veterinarios. De entre los países en desarrollo, la República de Haití presenta una especial vulnerabilidad biofísica. A lo largo del tiempo ha sufrido un gran número de seísmos, ciclones, inundaciones, sequías y epidemias que han fragilizado aún más el país, que ya de entrada contaba con escasos recursos económicos. Pese a ello, Haití trata de hacer frente a las amenazas biológicas modernizando sus Servicios Veterinarios y aplicando las normas sanitarias y directrices de la Organización Mundial de Sanidad Animal (OIE) con el fin de instituir sistemas de sanidad animal dotados de resiliencia.

Surveillance of avian influenza in the Caribbean through the Caribbean Animal Health Network: surveillance tools and epidemiologic studies.

The Caribbean region is considered to be at risk for avian influenza (AI) due to a large backyard poultry system, an important commercial poultry production system, the presence of migratory birds, and disparities in the surveillance systems. The Caribbean Animal Health Network (CaribVET) has developed tools to implement AI surveillance in the region with the goals to have 1) a regionally harmonized surveillance protocol and specific web pages for AI surveillance on www.caribvet.net, and 2) an active and passive surveillance for AI in domestic and wild birds. A diagnostic network for the Caribbean, including technology transfer and AI virus molecular diagnostic capability in Guadeloupe (real-time reverse transcription-polymerase chain reaction for the AI virus matrix gene), was developed. Between 2006 and 2009, 627 samples from four Caribbean countries were tested for three circumstances: importation purposes, following a clinical suspicion of AI, or through an active survey of wild birds (mainly waders) during the southward and northward migration periods in Guadeloupe. None of the samples tested were positive, suggesting a limited role of these species in the AI virus ecology in the Caribbean. Following low pathogenic H5N2 outbreaks in the Dominican Republic in 2007, a questionnaire was developed to collect data for a risk analysis of AI spread in the region through fighting cocks. The infection pathway of the Martinique commercial poultry sector by AI, through introduction of infected cocks, was designed, and recommendations were provided to the Caribbean Veterinary Services to improve cock movement control and biosecurity measures. The CaribVET and its organization allowed interaction between diagnostic and surveillance tools on the one hand and epidemiologic studies on the other, both of them developed in congruence with regional strategies. Together, these CaribVET activities contribute to strengthening surveillance of avian influenza virus (AIV) in the Caribbean region and may allow the development of research studies on both AI risk analysis and on AIV ecology.

Interaction between research and diagnosis and surveillance of avian influenza within the Caribbean animal health network (CaribVET).

The Caribbean region is considered to be at risk for avian influenza (AI) because of predominance of the backyard poultry system, important commercial poultry production, migratory birds and disparities in the surveillance systems. The Caribbean animal health network (CaribVET) has developed tools to implement AI surveillance in the region: (i) a regionally harmonized surveillance protocol, (ii) specific web pages for AI surveillance on http://www.caribvet.net, and (iii) a diagnostic network for the Caribbean including AI virus molecular diagnostic capability in Guadeloupe and technology transfer. Altogether 303 samples from four Caribbean countries were tested between June 2006 and March 2009 by real time PCR either for importation purposes or following clinical suspicion. Following AI H5N2 outbreaks in the Dominican Republic in 2007, a questionnaire was developed to collect data for risk analysis of AI spread in the region through fighting cocks. The infection pathway of Martinique commercial poultry sector by AI through introduction of infected cocks was designed and recommendations were provided to the Caribbean veterinary services to improve fighting cock movement controls and biosecurity measures. Altogether, these CaribVET activities contribute to strengthen surveillance of AI in the Caribbean region and may allow the development of research studies on AI risk analysis.